November 5, 2025 • 37 mins
Did you know most doctors receive almost no formal training in nutrition? In this eye-opening episode, Dr. Sabrina Falquier sits down with internal medicine specialist, Dr. Thomas Carter, and third year medical student, Megan Roach, for an honest conversation about how much nutrition has been taught in medical school and what that means for patient care. Together, they compare experiences, share insights from both generations of medicine, and discuss why culinary medicine is helping bridge the knowledge gap.
In this episode you’ll hear:
1:00 – How much nutrition is taught in medical school?
8:20 – Why Dr. Carter agreed to be a guest on this episode
10:00 – Nutrition education in medical school: Megan Roach’s perspective as a medical student
13:00 – Culinary medicine workshops in medical school
14:20 – Food as medicine
15:00 – What every medical student should learn about nutrition
17:00 – The challenge of speaking with patients about nutrition
19:30 – What Dr. Carter wishes he knew about nutrition
21:00 – How do you talk to a patient about nutrition?
26:45 – How to give nutrition advice in short appointments
31:30 – Nutrition training: The hope for future doctors
Referenced in the episode:
Host – Dr. Sabrina Falquier, MD, CCMS, DipABLM
Sound and Editing – Will Crann
Executive Producer – Esther Garfin
©2025 Alternative Food Network Inc.
Show Topics Include: Nutrition, Food as Medicine, Microbiome, Metabolism, Weight loss, Gut health, Healthy recipes, Lower cholesterol naturally, Reverse heart disease, Health, Inflammation, Mediterranean Diet, Longevity, Turmeric benefits , Cortisol Stress, Blood sugar, Protein, Magnesium, Sleep quality, Immunity, Hormone balance, Sunday meal prep, Medically tailored meals (MTM), Produce Prescription (PRx), ROI of Food as Medicine programs, Healthcare cost reduction, Prevention nutrition, Culinary medicine program curriculum for hospitals, Teaching kitchen, Health equity, Evidence-based nutrition interventions
In this episode you’ll hear:
1:00 – How much nutrition is taught in medical school?
8:20 – Why Dr. Carter agreed to be a guest on this episode
10:00 – Nutrition education in medical school: Megan Roach’s perspective as a medical student
13:00 – Culinary medicine workshops in medical school
14:20 – Food as medicine
15:00 – What every medical student should learn about nutrition
17:00 – The challenge of speaking with patients about nutrition
19:30 – What Dr. Carter wishes he knew about nutrition
21:00 – How do you talk to a patient about nutrition?
26:45 – How to give nutrition advice in short appointments
31:30 – Nutrition training: The hope for future doctors
Referenced in the episode:
- Proposed Nutrition Competencies for Medical Students and Physician Trainees
- Medicina Culinaria podcast in Spanish
- Buy Me a Coffee
Host – Dr. Sabrina Falquier, MD, CCMS, DipABLM
Sound and Editing – Will Crann
Executive Producer – Esther Garfin
©2025 Alternative Food Network Inc.
Show Topics Include: Nutrition, Food as Medicine, Microbiome, Metabolism, Weight loss, Gut health, Healthy recipes, Lower cholesterol naturally, Reverse heart disease, Health, Inflammation, Mediterranean Diet, Longevity, Turmeric benefits , Cortisol Stress, Blood sugar, Protein, Magnesium, Sleep quality, Immunity, Hormone balance, Sunday meal prep, Medically tailored meals (MTM), Produce Prescription (PRx), ROI of Food as Medicine programs, Healthcare cost reduction, Prevention nutrition, Culinary medicine program curriculum for hospitals, Teaching kitchen, Health equity, Evidence-based nutrition interventions
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
How many hours of nutrition did you get in your training.
Speaker 2 (00:04):
I completed my medical school in three in residency and
six and if I add up the total number of
hours between them, I think it comes to zero or
maybe half an hour.
Speaker 1 (00:17):
Welcome to Culinary Medicine Recipe. I'm so happy you're here.
I'm your host, Doctor Saprina Falke. I was a primary
care doctor for sixteen years and went to school for
four years to specialize in culinary medicine. In this work,
I get to combine my passionate expertise in both medicine
and food to teach people about food is medicine and
to empower them to understand what ingredients optimize health and
(00:39):
also how to cook those ingredients to make delicious meals.
On the show, I interviewed top chefs, doctors, healthcare visionaries,
and food service professionals who are making great strides in
the field of culinary medicine. Join me as we continue
to explore the amazing world of culinary medicine, where I
will empower you to make changes to your health and
wellness with great food. Right away. Hi, everyone, I'm so
(01:03):
excited for today's episode. I'm speaking with a seasoned physician
and a medical student about their nutrition education or lack thereof,
and we're going to compare notes. Historically, physicians have received
very little nutrition education, an average of only about twenty
hours of total nutrition education in medical school from a
twenty ten survey, and a survey in twenty twenty three
(01:24):
found that just about one point two hours per year
on average, with more than half of the medical students
reporting no formal nutrition courses at all. So how do
we get to a future state where food and nutrition
are as much a part of healthcare as a blood
pressure check? That line from the article published by Food
Tank title Food is Medicine and the Future of Care
Delivery has been on my mind. That's the backdrop for
(01:46):
today's conversation with Megan Roach, a thirty year medical student
u SEE San Diego School of Medicine, co founder of
its first culinary Medicine program and student interest group, recipient
of a National Nutrition Research Award, and presenter of supporting
research from these hands on workshops at the Lifestyle Medicine
Conference in November of twenty twenty five. Joining her is
(02:07):
doctor Thomas Carter, an internal medicine physician with nearly two
decades of clinical practice and medical education experience, founder of
Carter Medical Corporation in his hometown of Solano Beach, California,
and the leader in bringing longevity focused lifestyle management into
patient care. Together, we'll explore what's missing, what's changing, and
how food can become a standard part of medical care.
(02:29):
I'm recently back from Pasadena, where I led two breakout
cooking demonstrations for practicing clinicians at the Southern California Permanente
Medical Group. The room reached capacity so quickly that, due
to fire code regulations, the number of attendees had to
be cut off. There were physicians and health professionals already
established in their careers, yet they listened with full attention,
(02:50):
leaned in as I prepared recipes. Together, we explored practical
techniques for cooking, understanding ingredients, and becoming comfortable adjusting dishes
for personal preference, allergies, and culture nuances. So from the
classroom to the clinic, the appetite for this work is undeniable.
At U SEE, San Diego, we run hands on culinary
medicine workshops for medical students, and when registration opens it's
(03:11):
thirty spots, it fills in under half an hour and
there's a wait list just as long. Students across healthcare,
including future physicians, physician assistants, and graduate students, are eager
to learn to integrate evidence based nutrition and food into
patient care, so the demand today is clear. Before we
get into the conversation, I want to let you know
that I'm hosting a Spanish language podcast about culinary medicine
(03:32):
called Medicine equitin Nadia. It's already live with the season
of episodes. If you know people, or have patients or
clients who'd be interested in hearing more in Spanish, please
help spread the word about Medicine Equity Nadia. It's available
wherever you listen to your podcasts, and the link will
be in the show notes. Also, Alternative Food Network, which
produces a show, has joined Buy Me a Coffee, which
(03:53):
is a quick and easy way for our audience to
support us. So if you love this show, please consider
supporting Alternative Food Network on buy Me a Coffee at
buy Me at Coffee dot com. That link is also
in our show notes and it's just a couple of taps.
Now onto today's episode. I've had the pleasure of knowing
doctor Thomas Carter since we both did internal medicine residency
(04:14):
together at UCSD a few decades about, and Megan wrote,
and I have known each other creating and beginning the
culinary medicine program at UCSD. So thank you both so
much for being here. And I will say, doctor Carter,
I know your full credentials, but knowing how far back
we go, I'm going to call you Tom. If you're
okay with that.
Speaker 2 (04:34):
Yep, that works for me.
Speaker 1 (04:36):
Okay, how many hours of nutrition did you get in
your training?
Speaker 2 (04:40):
I completed my medical school in three and residency and six,
and if I add up the total number of hours
between them, I think it comes to zero or maybe
half an hour as far as nutrition, you know, I
think that we got a lot of information about maybe
amino acids and carbohydrates and other things involved in biochemistry.
(05:04):
But I don't remember discussing nutrition at least not in
any kind of structured way or in any way that's
stuck with me through becoming a primary care doctor.
Speaker 1 (05:13):
So let's fast forward to present times. Megan, how are
things now?
Speaker 3 (05:18):
I wish I could say that a lot has changed.
Speaker 4 (05:21):
I think if I were to exclude the efforts that
you and I.
Speaker 3 (05:25):
Have embarked on.
Speaker 4 (05:27):
It would be pretty close to Tom's answer in that
I think the beauty of medical schools that we have
a lot of foundational knowledge, but the actual applied nutritional
knowledge direct is pretty minimal.
Speaker 3 (05:42):
I think a couple of hours.
Speaker 4 (05:44):
I can remember a couple of lectures from our GI
block and not much beyond that.
Speaker 1 (05:50):
So why do you guys think that historically there's been
so few hours in the curriculum.
Speaker 2 (05:55):
I mean, I can speak to my remote experience at
this point, and I think it just, you know, those
lectures were packed, and people were trying to get lectures,
were trying to get through a certain set of material
that would beyond the step exams or relevant to my
you know, management of a hospitalized patient. So they really
didn't focus on it in primary care. I don't think
(06:17):
in general was or chronic disease management maybe was maybe
a better term to use. Chronic disease management really wasn't
something that was emphasized in medical school or residency. We're
focused on acute care. We're focused on like triage and
admitting somebody to the hospital and then discharging them from
the hospital.
Speaker 4 (06:37):
Yeah, I'd have to agree and add on to that
that I think that people don't know what to teach,
and for multiple reasons. One because we're taught by doctors
most of the time in medical school, and that's such
a great thing, but it also means that if they
didn't receive that formal training, then they don't feel comfortable
(06:57):
unless they've sought it out themselves, unless they feel.
Speaker 3 (07:01):
They're an expert in it.
Speaker 4 (07:02):
They and most doctors don't because of the lack of
training early on, they don't.
Speaker 3 (07:09):
Feel comfortable teaching it.
Speaker 4 (07:10):
And then I think beyond that, there's so many applications
of nutrition where there's not an agreement by research and
experts and different diets, and so I think that disconcordance
makes it so that there's not a curriculum for medical students.
Speaker 1 (07:29):
You make such a good point again, because it's such
a generational as a generation before doesn't have the skills,
how are they going to pass it on to the
future generations of physicians.
Speaker 2 (07:38):
Yeah, and I would add just not that they're just doctors,
but they're also people, and most people don't have a
good understanding of nutrition. They have their family recipes and
they have their kind of go to dinners or what
have you. But they don't necessarily have confidence that they
know what they're talking about, let alone in their own
family or their own social dynamic. In front of a
(07:58):
classroom even more intimidating to sort of start spouting off
about nutrition information.
Speaker 1 (08:05):
Yeah, And I would add to that, how there's such
an experience of using anecdotal So if you had a
patient that had a success with a certain eating pattern,
or a relative or yourself, that's the information that's passed
forward rather than focusing on evidence based nutrition. Now, Tom,
why did you agree to come onto this episode?
Speaker 2 (08:25):
You know, I'm I'm a primary care doctor and now
I operate a private internal medicine clinic, and so I
have a lot of time, thankfully with my patients now,
but for the last eighteen years, I probably had nine
to thirteen minutes with them, independent of their medical complexity
or their age or anything else. And so I always
(08:49):
knew that nutrition education was something that I wanted to
be able to provide and didn't have the time to
do it. I now have the time to do it,
and I'm still inadequately educated as to how to do it.
And so I would say that the reason I agreed
to come on would be I'd like the conversation. I
think primarily what I'm noticing with my clients these days
(09:11):
is that mostly they ask me what I do, like,
what do I eat, how do I exercise? And how
do I live my life? And I'm trying to bridge
the gap so that I can, you know, educate and
care for somebody, but also provide some window into my lifestyle. Frankly,
I want to learn more to be a healthy individual.
(09:32):
And so I agreed to come on because you know,
we go way back, and I'm always happy to have
a conversation with you, but also because I'm a perpetual
learner in this area and identifying the best ways to
get across you know, reasonable actionable information regarding nutrition is
basically needed every single day that I see patients.
Speaker 1 (09:56):
So, Megant, what drew you? I still remember the day
I met you, when you and Ekshaa came up to
me after a lecture and wanted to dive deeper into
culinary medicine. And I'm still in awe of truly how
you ran with that. So what drew you to want
to engage with culinary medicine and dive deep into working
not only with me, but also with administration and colleagues
(10:19):
and mentors to shape the beginning of culinary medicine at
UCSD School Medicine.
Speaker 4 (10:25):
If I think back that that was such a great day.
I was very enamored by you and the work that
you do. And I think that it goes back to
college for me, where I had some personal changes that
I made. I saw a real change to my body.
I was a runner in high school. I saw a
real change to my body, and like the way that
(10:45):
I felt every day.
Speaker 3 (10:47):
I was getting sick all the time, and.
Speaker 4 (10:50):
My grades were not great for my first year of school,
and so I just think that once I started my
sophomore year, I had room to cook in a house
with friends and roommates that also wanted to cook, and
we got really into that. And I became a vegetarian
because I got deep in the Netflix documentaries and just
(11:11):
wanted to do it for environmental reasons, and so we
got super into plant based cooking, and I noticed that, honestly,
everything changed. My grades improved, my sleep improved, my social
connectedness improved through food, and it just became such a
joy for me that I had never had any formal
(11:34):
expertise or exposure and it just became something that I
felt like changed my life.
Speaker 3 (11:38):
I was looking for that in my.
Speaker 4 (11:40):
Next phase of life and in my next formal learning opportunity.
And I actually thought that in medical school I would
learn all of that. And so I think that coming
into medical school and realizing that wasn't going to be
something that yes, I would get all the biochemistry knowledge,
but I wouldn't get the this is how you counsel
(12:01):
patients and all of the preventative measures.
Speaker 3 (12:05):
I was a little disappointed.
Speaker 4 (12:07):
And I think when I saw you speak, it really
opened my eyes that people.
Speaker 3 (12:11):
Are doing it, but that we were.
Speaker 4 (12:13):
Going to have to seek it out a little bit harder.
Speaker 1 (12:16):
There's a few things you just brought up. So number
one is for a lot of us, whether it's a patient,
and again, like you said, Tom, we're all people that
eat that there's often this awakening moment and it can
come from a personal experience. And I see that as
kind of a target of having to think about ourselves
and what change we do, and then if we see
that change, then taking it outward. And that's what I
(12:37):
have loved about what got you interested in this and
then taking it beyond yourself of realizing how do I
find this and when you didn't find it in medical school,
how do I create it? Which is giant.
Speaker 5 (12:50):
Let's surprise you the most of the process of developing
the workshops, and how have you found that these workshops
are different than traditional kind of You mentioned biochemistry a
couple of times, how that nutrition teaching that you've gotten.
Speaker 4 (13:04):
I'll start with the obvious change between them is that
there's the hands on component, and that has been so
crucial to get students involved and to learn like experientially,
because that's not something that everyone feels comfortable or equipped
to do at home. And I think that a lot
(13:25):
of the reason that people don't have these skills is
because it feels like there's such a.
Speaker 3 (13:32):
Barrier to entry.
Speaker 4 (13:34):
So I think that lowering that by offering some kind
of hands on learning with some supervision and teaching, is
crucial to people actually taking it home. Learning any kind
of lecture, people are half listening and plan to go
do more at home. But I think this is one
(13:54):
of the things where you can't just go home and
watch a video and just get it. It's something that
you really have to get from being like, oh, I'm
holding the knife this way.
Speaker 1 (14:04):
There is added value and really thinking of the teaching
kitchen that we create as a learning lab, right, so
we are learning these skills, we're learning about working in community.
So yes, a lot of learning thresholds. If you had
to guess what percent of your peers or colleagues actively
embrace food is Medicine today.
Speaker 2 (14:23):
Yeah, I think that there's a very low number of
people that would disagree with the idea in its conceptual form.
The question is do they apply it to their daily practice?
I would think, and I think very very few is
the answer. And it's not because anybody's doing anything wrong.
It's simply that it's not a skill set and it's
(14:45):
not something that's incentivized in large health systems or even
academic medical centers where you're trying to work through, especially
in internal medicine, people with multiple medical issues and competing priorities.
Speaker 1 (15:00):
All Right, So Megan, as you've gone through this process
and now you've started to see patients in different capacities,
what is one skill or concept that you learned that
you wish every med student could take or that you
have experience now with some patients.
Speaker 4 (15:15):
I think in a patient setting, I haven't had as
much experience to bring up nutrition as much as I
wish that I had. I'm pretty early in my third year,
but I think in terms of culinary medicine in general
and the skill that I wish I could have applied
(15:36):
to all my classmates and honestly to all of the
patients that I meet, if we had the chance to
speak about it would be ingredient preparation rather than meal preparation.
And this is speaking mostly to like people who feel
very busy all the time, and I think that's a
huge barrier to entry for just cooking in general and
(15:57):
having home prepared meals. And that's something that we've emphasized
in the workshops of just preparing ingredients rather than entire meals,
because if you make one big you know that of chili,
like you said, and then you have to eat that
for lunch and dinner and lunch and dinner and on repeat,
and then you're sick of that recipe. And I think
(16:21):
that can be kind of disheartening when you get up
the courage to cook yourself a home cooked meal. So
I think that's something that a lot of my classmates
have struggled with, and just a lot of people struggle
with in general that I try to mitigate with just
ingredient preparation and really looking at cooking as something that
(16:41):
you get to do every day, but not something that
you have to do that's going to take so long.
So we've shown, you know, preparing your greens and washing
and cutting and then preparing like a veggie saute and
then maybe some beans, or we've showed the ways that
you can create various ingredients that are going to be
(17:02):
quick to throw together, but in completely different organizations.
Speaker 2 (17:08):
What I end up stuck on with patients oftentimes is
they want to know what diet to follow, and they're
not actually looking for nutrition advice or meal preparation advice.
They want to basically sign up for a diet. Maybe
they don't really want to, but that's what their friends do,
and that's what their family does. They're vegan or their carnivore,
or there's some infinite derivation of either of those, and
(17:32):
I think that becomes an identity thing oftentimes. And so
the problem with diet as a term, and something I
try to avoid talking about, is that people hold very
strongly to the identity of being such a person, a
vegan or a carnivore or a keto or paleo or
whatever it might be. And so what I try to
do is walk people back from that. And I think
what Megan was highlighting, at least what I heard was
(17:55):
it's a skill set of being creative with nutritional ingredients,
and those are common to all these different diets. They
don't have to be dogmatic. You can get benefit out
of some carnivore, some paleo, and some vegan. That's called
a balanced meal probably, you know. But if you call
it the Mediterranean diet, people will say, oh, yeah, I
know that I should eat olive oil and feta cheese
(18:16):
or something. So I like to really emphasize the idea
that this is a skill set and the ingredient focus
is really the important thing, because if you have it
in the house, you'll be able to use it to
create your meal. If you have a bag of chips,
you'll be able to consume that quicker than you would
ever create a meal. And so I try to focus
on their habits. Frankly, when it comes to shopping, when
(18:40):
it comes to discussion of meal preparation, it's don't buy
the thing you know you're going to consume. If it's
in the house. Because willpower is sort of a fleeting energy.
I try to focus on, Okay, buy the stuff that
would be good to eat if you end up eating it,
you know, and then next step, let's create some meals
out of it. And I just appreciate what Megan said
about that it is a barrier for people to start
(19:02):
thinking about it. I got to have a recipe, and
I need a quarter a teaspoon of nutmeg or something,
you know, I don't have nutmeg. It turns out the
recipe is going to be pretty much fine without the nutmeg,
you know, like you can get most get ninety percent
of the ingredients and you'll be all right. It's not
about diet. It's about nutrition. It's about starting to get
creative with the ingredients you have and setting yourself up
for success by buying those things at the store.
Speaker 1 (19:24):
So coming back into the clinic for a bit, you
may or may not be aware that there was actually
In twenty twenty four, doctor David Eisenberg of the Harvard
School of Public Health, along with colleagues, published a new
set of competencies in JAMA Network Open, looking at competencies
to be incorporated into medical school curriculum, and the goal
(19:46):
really is looking at nutrition to really bring it in,
giving the language to medical students to understand, to be
able to take it to the next step. So, Tom,
when you look back, is there a skill that you
wish you had learned, Like, if you had to, Okay,
I'm going to have four hours of nutrition education or
food conversations, what do you feel would have been kind
(20:06):
of the highest ticket item on that list?
Speaker 2 (20:10):
I mean, I don't want to sound flippant, but the
most I mean the thing I could have gotten the
most out of, or the thing I would have received
the most benefit from, would have been to be taught
how to cook five dinners in a week within twenty minutes.
You know, basically the thing that most people are dealing with,
which is the pressure of time. And maybe I don't
(20:30):
need to know all the reasons why this particular nutritional
component is so good for my mitochondria or what have you.
I just need to know that this is a good choice,
because that's human behavior. And if I can explain it
to myself and make my dinner in a healthy way,
there's a higher likelihood I'll be able to explain that
to a patient or a friend who might be in
(20:51):
need of it. If I become distracted and go down
the rabbit holes of macronutrients, micronutrients, supplements and all of
those things, nobody's going to pay attention, you know, at
least not for very long.
Speaker 1 (21:04):
So going along with that, when we're now looking at
ethics and food programs, how do you balance offering helpful
resources without steering patients to one company or one product
or one specific diet or a way of eating. And
what are the ethical considerations that you take into account
with this.
Speaker 2 (21:22):
Here's the thing I did a when I was in
a residency. I had a clinic that was in a
lower socioeconomic area of the county, and people really didn't
have resources to go to the high end grocery store
or go to a restaurant where they're going to get
a salad or something, and so I was always left
(21:42):
with saying something to people like don'y white rice or
dony tortillas, and frankly I knew because you can see
it in their eyes. As soon as you say that,
they basically tune you out because that's what they're going
to eat, you know. And it's not because they're trying
to worsen their diabetic contry, but it's their culturally appropriate
(22:02):
and important food, and so, you know, the thing that
I ended up learning was that instead of saying don't
eat this, don't eat that, I would try to offer alternatives,
like more veggies instead of that pile of rice or
you know, whole weed versions of things. Even that didn't
always get a lot of purchase, but at least it
(22:24):
made it clear that I was trying to stay aligned
with their cultural what was important to them culturally. Nowadays,
I don't worry as much about shying away from specific
recommendations regarding grocery stores or products, because I feel like
my main objective is to help my patients or clients
(22:45):
actually do what they need to do. And the more
specific you can be, the more helpful you can be.
I think, when you're dealing with the person in front
of you, it's important to know where they live, what
resources they have access to, and then do your research.
Go to the store and figure out what do they
actually say sell there, and you can say, hey, on
Aisle three, they got kale.
Speaker 1 (23:02):
You know, I loved hearing how you transitioned Again, you're
in residency with not much education around this topic, and
you are in the trenches now, Megan, do you want
to add anything to this. I do.
Speaker 4 (23:16):
I've just been loving hearing from both of you about
how your focus is really less about what specific diet
to prescribe or recommend, and I agree that it's really
not about that at the end of the day, and
that's great news for every physician who feels that they
don't have an adequate understanding of which diet is better
(23:39):
than another, because I think that at the end of
the day, it's just about getting people to eat more
of what's fresh and what brings them joy.
Speaker 3 (23:50):
And I think that really diving.
Speaker 4 (23:52):
Into what foods are comforting and which ones are comforting
and go for you, and really trying to understand what
is someone's health literacy as long as you're trying to
tailor it to your specific patient and their background. And
(24:13):
that's something that we've really tried to do in our
workshops and something that I really appreciate too, because again, yeah,
the Mediterranean diet is evidence based, but it's really not
that inclusive and it doesn't apply to every food that everybody.
Speaker 3 (24:28):
Enjoys and grew up knowing.
Speaker 4 (24:30):
And I think that's one of the best things about
food is that people think about things that my mom
made or in our workshops we know applied other cultural
cuisines and our entire premises these are the Mediterranean diet principles,
and here's how you apply it to other cultures. And
(24:52):
we got feedback from students who wrote in saying, my
mom made this, or my grandma made this, or.
Speaker 3 (24:58):
I order it take out. I didn't know that you
could just make it.
Speaker 4 (25:02):
And food can be incredibly empowering to know how to
make it yourself. And someone's relationship with food is just
as important as what they're actually eating.
Speaker 2 (25:15):
That is such an important point, and it applies to
many different aspects of behavior change. I would say that
not emphasizing getting down on yourself for lapses from whatever
the ideal plan you had created at the beginning of
the week is one of the more important things that
I think I've found in direct patient care. I think
(25:35):
it's important to also advocate for people to feel good
about themselves in getting back on track after lapse or
after something that maybe doesn't meet the perfect nutritional guidelines.
It's also, I think really important to give people credit
for small improvements and to encourage them to give themselves
(25:55):
credit for small improvement. So if they go from eating
out seven nights a week to creating two meals in
a week, that's a huge improvement. And that's sort of
that you know, coefficient of static friction or whatever the
term was in physics where it's the hardest thing to
overcome is that inertia of never cooking to cooking just
a little bit. And if they can do that, just
(26:17):
like if they can go for a one mile walk
or a ten minute jog or something like that, they've
started that process of habit change. And that's really what
human behavior is all about. That's where I try to
lean in and I say it, great, you made two things.
What were they?
Speaker 1 (26:31):
You know?
Speaker 2 (26:31):
I'm interested to learn, And again, asking and being curious
is more more valuable than lecturing and saying, hey, you
got to you know, eat this many carbs and grams
of fat.
Speaker 1 (26:43):
Et cetera. How realistic is it for a clinician to
give practical food or meal advice in a fifteen minute visit? Tom,
I'll start with you, since you've had many decades of
experience with this.
Speaker 2 (26:54):
Geez, many decades. I've had a couple of decades of
experience with this type of visit. I've chosen a practice
now where I have a little more time, which I appreciate,
but I can still tell you that there's never enough
time to fully address every issue that a person wants
to discuss or needs to discuss. And so the strategy
(27:17):
that I encourage amongst other physicians and residents and medical
students is not to try to solve the problem in
fifteen minutes, but to simply start the conversation, because at
least in primary care and in many specialty clinics where
they're seeing people over and over again, these are conversations
which can occur over and over again and progress over
(27:41):
the relationship with your physician. And I think that's the
most valuable thing, is that if they have consistency, if
the patient comes in and knows, oh, doctor Carter's probably
going to ask me how I'm doing with my nutrition,
I better have a recipe this time that I know
to tell him, because he keeps asking me what's the
recipe that you're going to make tonight, which is the
thing I ask. I try to act very I try
(28:01):
to ask a specific question, and so I think iterative
repetitive questioning over multiple visits about what people are eating
or what they are going to make that night is
actually my biggest recommendation, just like it is for exercise.
What is the exercise you're going to do today? Is
the question? Not in general what do you do for exercise?
(28:24):
Because then people say, even if they're sixty years old, oh,
I played high school football. You know, well great, you know,
but that.
Speaker 1 (28:32):
Was a few decades ago.
Speaker 2 (28:33):
That one that's not relevant anymore, you know, Or I
used to be a vegan four years ago, like, okay,
well what are you going to make for dinner tonight?
You know, that's really the question. And so to get
back to your question, fifteen minutes is inadequate to address
fully anything any topic. You can do tactical addressing of
certain things that are acute. You can check some boxes.
(28:55):
But what you really need, as a physician, I think
to get comfortable with is that these are longitudinal conversations
that are occurring in fifteen minute increments over a period
of ten years and so or more. And if you
do that, then their relationship develops. And caregiving is about relationships,
and nutrition can weave into that just like all other
aspects of that physician patient relationship.
Speaker 1 (29:17):
Do you want to reflect on that Megan is starting
this journey.
Speaker 4 (29:22):
Yeah, I mean I love that approach. I think it's
very inspiring to I mean, we learn about the basics
of motivational interviewing. That's something that medical school does really
touch on because it comes.
Speaker 3 (29:35):
Up in so many different aspects.
Speaker 4 (29:37):
And people really have it dialed with smoking, cessation and exercise,
but then it does seem like with nutrition we shy
a little bit further away.
Speaker 3 (29:47):
And I want to touch on the fact that.
Speaker 4 (29:49):
I think the beauty of although you can't fit an
entire overhaul or an entire you know, deep dive into
someone's relationship with food or have it changes in fifteen minutes,
I think you can touch on it. And I think
that continuity is important. But even just for people that
don't have that privilege of continuity, I think it's worth
(30:13):
it because I think people want to know that their
doctor cares. And the beauty of culinary medicine is also
that it's interdisciplinary. And I've been in many settings now
where actually the dietician is leading that conversation, but the
physician is beautifully teeing them off.
Speaker 3 (30:32):
Because we learn about, you.
Speaker 4 (30:34):
Know, real blood pressure changes when a physician walks into
the door and things like that, like coat syndrome. People
do care about what their physician says, and I think
being able to reinforce that with other members of the
team is really important and it just gives people more
touch points.
Speaker 1 (30:56):
So, where as we're closing up here, is there anything
I didn't ask you that you wish I had, so
please share that?
Speaker 5 (31:03):
Or what's one thing that you hope med.
Speaker 1 (31:05):
Schools to do differently in the next five years?
Speaker 4 (31:08):
Your question about what do I hope that med schools
will do differently in the next five years tease us
off very well from the conversation we were just having,
because I do think that my biggest passion about our
project with the workshops has.
Speaker 3 (31:24):
Been that I really have wanted.
Speaker 4 (31:28):
People to focus on themselves first and really build that
skill set for their own week night, you know, dinner,
and feel more comfortable with it themselves because it's such an.
Speaker 3 (31:43):
Element of wellness.
Speaker 4 (31:44):
It is one of the biggest ways that I stay well,
and I just find so much power in that and
being able to do that and not feeling helpless and
you know, creating a meal that makes you, in turn
feel really good. I think that that component of wellness
is something I hope gets integrated into medical schools because
(32:06):
they are so passionate about wellness. And I think there's
been many conversations from the medical school even asking us,
and I really commend UCSD for asking students like, what
do you want your wellness to look like? And I
have raised my hand in a big auditorium and said,
I think we need more gulinary medicine. And I hope
(32:26):
that they did that and run with it eventually, but
it hasn't happened yet. But I think that they are
starting to realize that if you can do it yourself,
then you can help patience. And we're starting with that
first step, and a lot of my classmates have actually
really bought in. And I've been getting texts like weekly
to monthly of somebody sending me a picture of something
(32:49):
that they made and saying, look how good this looks,
or I was inspired by you or your workshop, And
it's just been such a joy to see people just
take it for themselves and about.
Speaker 3 (33:00):
The patients too. But right now, my goal is to really.
Speaker 4 (33:02):
Get people to incorporate that into their own lives and
then feel confident with just sharing it with a patient
like they would share it to a friend.
Speaker 2 (33:11):
As far as a closing reflection, this is really fun,
and I hope we get to keep having interviews over
a podcast. Thank you. And I think that a reflection
is that we're all I mean, we're really all just
trying our best for the most part, I would say,
and it doesn't really benefit anybody to pretend that you're
an expert in something you're not an expert in. And
(33:34):
I think that took me a long time to let
go as a professional physician, because there is this sort
of attitude that people are coming to you for knowledge,
for your knowledge, for your experience, and for you to
basically give them the answer. I think that's maybe a
relic of my educational time in your Sabrina, where we
(33:55):
were essentially wrote learning and spitting it out and memorizing
mnemonic so that we could get at all of the
criteria of acidic fluid and plural fluid, right, And that
Creb cycle that I kind of is, you know distantly,
Remember I don't remember the Creb cycle. So hopefully I
can reassure you that you will not need to know
it at some point. I've never said ATP in the
(34:16):
clinic in my entire life, So just so you know,
and and I think that I would, I would hope,
and I'm and I'm you know, a facult a clinical
faculty faculty member at UCSD, and I'm hoping to impart
this sort of attitude over time as well, that there
is a role for knowing that information for a period
(34:38):
of time. But really the art and the practice of
medicine is about partnership with other human beings, and so
learning the skill set to live your own life in
those ways is probably the most powerful way you can
help others, because that's how we teach each other. We
teach each other what we do, and they see us
as examples. It's something that I think about because I
(35:00):
I do now try to live in the way that
I ask my patients to try to live. And I
think we just have to understand that that could start
way earlier in medical school, even earlier probably, but as
you arrive in medical school, I'd love students to be
able to be encouraged to learn a few good recipes
and to learn a few good exercises, and maybe some
(35:22):
creative outlet like reading a novel and other things that
are good for your brain and totality rather than just
cramming information.
Speaker 5 (35:31):
So, Tom, how can people reach you?
Speaker 2 (35:34):
I have email? My email is Tom at Cartermedicalcorp dot com.
Speaker 5 (35:40):
How about you, Megan.
Speaker 4 (35:41):
I'm very passionate to share, and the best way would
probably be email right now because I am checking it
all the time.
Speaker 3 (35:49):
So mroacch Roach like the bug at UCSD dot edu.
Speaker 5 (35:58):
Perfect. Thank you both so much.
Speaker 1 (35:59):
Was It's really fun and I really love to hear
the conversations of us in very different stages of our
career journey. So thank you Megan and Tom for this
time together.
Speaker 3 (36:11):
Thank you, Sara, thank you.
Speaker 1 (36:16):
Today's conversation with Megan Roach and doctor Thomas Carter highlights
both the progress and the gaps. We see the hunger
for culinary medicine from students who sign up within minutes
for culinary medicine workshops and from practicing clinicians who fill
every seed of cooking demonstrations to learn new skills. We
also see how little formal nutrition education most physicians still receive.
(36:37):
We're beginning to see signs of progress, though, with Congressman
Jim McGovern has spoken out in support of nutrition education
and medical training and the Eisenberg competencies have been published,
and some medical schools offer formal electives or even full
courses of culinary medicine, but we're not there yet. To
truly transform care, every medical school graduate, regardless of specialty,
(36:59):
needs to leave with practical nutrition knowledge they can carry
into their own unique practices. Until next time, salute and
buena Pettie. All content provided or opinions expressed in this
episode are for informational purposes only and are not a
substitute for professional medical advice. Please take advice from your
(37:22):
doctor or other qualified healthcare professional.
How many hours of nutrition did you get in your training.
Speaker 2 (00:04):
I completed my medical school in three in residency and
six and if I add up the total number of
hours between them, I think it comes to zero or
maybe half an hour.
Speaker 1 (00:17):
Welcome to Culinary Medicine Recipe. I'm so happy you're here.
I'm your host, Doctor Saprina Falke. I was a primary
care doctor for sixteen years and went to school for
four years to specialize in culinary medicine. In this work,
I get to combine my passionate expertise in both medicine
and food to teach people about food is medicine and
to empower them to understand what ingredients optimize health and
(00:39):
also how to cook those ingredients to make delicious meals.
On the show, I interviewed top chefs, doctors, healthcare visionaries,
and food service professionals who are making great strides in
the field of culinary medicine. Join me as we continue
to explore the amazing world of culinary medicine, where I
will empower you to make changes to your health and
wellness with great food. Right away. Hi, everyone, I'm so
(01:03):
excited for today's episode. I'm speaking with a seasoned physician
and a medical student about their nutrition education or lack thereof,
and we're going to compare notes. Historically, physicians have received
very little nutrition education, an average of only about twenty
hours of total nutrition education in medical school from a
twenty ten survey, and a survey in twenty twenty three
(01:24):
found that just about one point two hours per year
on average, with more than half of the medical students
reporting no formal nutrition courses at all. So how do
we get to a future state where food and nutrition
are as much a part of healthcare as a blood
pressure check? That line from the article published by Food
Tank title Food is Medicine and the Future of Care
Delivery has been on my mind. That's the backdrop for
(01:46):
today's conversation with Megan Roach, a thirty year medical student
u SEE San Diego School of Medicine, co founder of
its first culinary Medicine program and student interest group, recipient
of a National Nutrition Research Award, and presenter of supporting
research from these hands on workshops at the Lifestyle Medicine
Conference in November of twenty twenty five. Joining her is
(02:07):
doctor Thomas Carter, an internal medicine physician with nearly two
decades of clinical practice and medical education experience, founder of
Carter Medical Corporation in his hometown of Solano Beach, California,
and the leader in bringing longevity focused lifestyle management into
patient care. Together, we'll explore what's missing, what's changing, and
how food can become a standard part of medical care.
(02:29):
I'm recently back from Pasadena, where I led two breakout
cooking demonstrations for practicing clinicians at the Southern California Permanente
Medical Group. The room reached capacity so quickly that, due
to fire code regulations, the number of attendees had to
be cut off. There were physicians and health professionals already
established in their careers, yet they listened with full attention,
(02:50):
leaned in as I prepared recipes. Together, we explored practical
techniques for cooking, understanding ingredients, and becoming comfortable adjusting dishes
for personal preference, allergies, and culture nuances. So from the
classroom to the clinic, the appetite for this work is undeniable.
At U SEE, San Diego, we run hands on culinary
medicine workshops for medical students, and when registration opens it's
(03:11):
thirty spots, it fills in under half an hour and
there's a wait list just as long. Students across healthcare,
including future physicians, physician assistants, and graduate students, are eager
to learn to integrate evidence based nutrition and food into
patient care, so the demand today is clear. Before we
get into the conversation, I want to let you know
that I'm hosting a Spanish language podcast about culinary medicine
(03:32):
called Medicine equitin Nadia. It's already live with the season
of episodes. If you know people, or have patients or
clients who'd be interested in hearing more in Spanish, please
help spread the word about Medicine Equity Nadia. It's available
wherever you listen to your podcasts, and the link will
be in the show notes. Also, Alternative Food Network, which
produces a show, has joined Buy Me a Coffee, which
(03:53):
is a quick and easy way for our audience to
support us. So if you love this show, please consider
supporting Alternative Food Network on buy Me a Coffee at
buy Me at Coffee dot com. That link is also
in our show notes and it's just a couple of taps.
Now onto today's episode. I've had the pleasure of knowing
doctor Thomas Carter since we both did internal medicine residency
(04:14):
together at UCSD a few decades about, and Megan wrote,
and I have known each other creating and beginning the
culinary medicine program at UCSD. So thank you both so
much for being here. And I will say, doctor Carter,
I know your full credentials, but knowing how far back
we go, I'm going to call you Tom. If you're
okay with that.
Speaker 2 (04:34):
Yep, that works for me.
Speaker 1 (04:36):
Okay, how many hours of nutrition did you get in
your training?
Speaker 2 (04:40):
I completed my medical school in three and residency and six,
and if I add up the total number of hours
between them, I think it comes to zero or maybe
half an hour as far as nutrition, you know, I
think that we got a lot of information about maybe
amino acids and carbohydrates and other things involved in biochemistry.
(05:04):
But I don't remember discussing nutrition at least not in
any kind of structured way or in any way that's
stuck with me through becoming a primary care doctor.
Speaker 1 (05:13):
So let's fast forward to present times. Megan, how are
things now?
Speaker 3 (05:18):
I wish I could say that a lot has changed.
Speaker 4 (05:21):
I think if I were to exclude the efforts that
you and I.
Speaker 3 (05:25):
Have embarked on.
Speaker 4 (05:27):
It would be pretty close to Tom's answer in that
I think the beauty of medical schools that we have
a lot of foundational knowledge, but the actual applied nutritional
knowledge direct is pretty minimal.
Speaker 3 (05:42):
I think a couple of hours.
Speaker 4 (05:44):
I can remember a couple of lectures from our GI
block and not much beyond that.
Speaker 1 (05:50):
So why do you guys think that historically there's been
so few hours in the curriculum.
Speaker 2 (05:55):
I mean, I can speak to my remote experience at
this point, and I think it just, you know, those
lectures were packed, and people were trying to get lectures,
were trying to get through a certain set of material
that would beyond the step exams or relevant to my
you know, management of a hospitalized patient. So they really
didn't focus on it in primary care. I don't think
(06:17):
in general was or chronic disease management maybe was maybe
a better term to use. Chronic disease management really wasn't
something that was emphasized in medical school or residency. We're
focused on acute care. We're focused on like triage and
admitting somebody to the hospital and then discharging them from
the hospital.
Speaker 4 (06:37):
Yeah, I'd have to agree and add on to that
that I think that people don't know what to teach,
and for multiple reasons. One because we're taught by doctors
most of the time in medical school, and that's such
a great thing, but it also means that if they
didn't receive that formal training, then they don't feel comfortable
(06:57):
unless they've sought it out themselves, unless they feel.
Speaker 3 (07:01):
They're an expert in it.
Speaker 4 (07:02):
They and most doctors don't because of the lack of
training early on, they don't.
Speaker 3 (07:09):
Feel comfortable teaching it.
Speaker 4 (07:10):
And then I think beyond that, there's so many applications
of nutrition where there's not an agreement by research and
experts and different diets, and so I think that disconcordance
makes it so that there's not a curriculum for medical students.
Speaker 1 (07:29):
You make such a good point again, because it's such
a generational as a generation before doesn't have the skills,
how are they going to pass it on to the
future generations of physicians.
Speaker 2 (07:38):
Yeah, and I would add just not that they're just doctors,
but they're also people, and most people don't have a
good understanding of nutrition. They have their family recipes and
they have their kind of go to dinners or what
have you. But they don't necessarily have confidence that they
know what they're talking about, let alone in their own
family or their own social dynamic. In front of a
(07:58):
classroom even more intimidating to sort of start spouting off
about nutrition information.
Speaker 1 (08:05):
Yeah, And I would add to that, how there's such
an experience of using anecdotal So if you had a
patient that had a success with a certain eating pattern,
or a relative or yourself, that's the information that's passed
forward rather than focusing on evidence based nutrition. Now, Tom,
why did you agree to come onto this episode?
Speaker 2 (08:25):
You know, I'm I'm a primary care doctor and now
I operate a private internal medicine clinic, and so I
have a lot of time, thankfully with my patients now,
but for the last eighteen years, I probably had nine
to thirteen minutes with them, independent of their medical complexity
or their age or anything else. And so I always
(08:49):
knew that nutrition education was something that I wanted to
be able to provide and didn't have the time to
do it. I now have the time to do it,
and I'm still inadequately educated as to how to do it.
And so I would say that the reason I agreed
to come on would be I'd like the conversation. I
think primarily what I'm noticing with my clients these days
(09:11):
is that mostly they ask me what I do, like,
what do I eat, how do I exercise? And how
do I live my life? And I'm trying to bridge
the gap so that I can, you know, educate and
care for somebody, but also provide some window into my lifestyle. Frankly,
I want to learn more to be a healthy individual.
(09:32):
And so I agreed to come on because you know,
we go way back, and I'm always happy to have
a conversation with you, but also because I'm a perpetual
learner in this area and identifying the best ways to
get across you know, reasonable actionable information regarding nutrition is
basically needed every single day that I see patients.
Speaker 1 (09:56):
So, Megant, what drew you? I still remember the day
I met you, when you and Ekshaa came up to
me after a lecture and wanted to dive deeper into
culinary medicine. And I'm still in awe of truly how
you ran with that. So what drew you to want
to engage with culinary medicine and dive deep into working
not only with me, but also with administration and colleagues
(10:19):
and mentors to shape the beginning of culinary medicine at
UCSD School Medicine.
Speaker 4 (10:25):
If I think back that that was such a great day.
I was very enamored by you and the work that
you do. And I think that it goes back to
college for me, where I had some personal changes that
I made. I saw a real change to my body.
I was a runner in high school. I saw a
real change to my body, and like the way that
(10:45):
I felt every day.
Speaker 3 (10:47):
I was getting sick all the time, and.
Speaker 4 (10:50):
My grades were not great for my first year of school,
and so I just think that once I started my
sophomore year, I had room to cook in a house
with friends and roommates that also wanted to cook, and
we got really into that. And I became a vegetarian
because I got deep in the Netflix documentaries and just
(11:11):
wanted to do it for environmental reasons, and so we
got super into plant based cooking, and I noticed that, honestly,
everything changed. My grades improved, my sleep improved, my social
connectedness improved through food, and it just became such a
joy for me that I had never had any formal
(11:34):
expertise or exposure and it just became something that I
felt like changed my life.
Speaker 3 (11:38):
I was looking for that in my.
Speaker 4 (11:40):
Next phase of life and in my next formal learning opportunity.
And I actually thought that in medical school I would
learn all of that. And so I think that coming
into medical school and realizing that wasn't going to be
something that yes, I would get all the biochemistry knowledge,
but I wouldn't get the this is how you counsel
(12:01):
patients and all of the preventative measures.
Speaker 3 (12:05):
I was a little disappointed.
Speaker 4 (12:07):
And I think when I saw you speak, it really
opened my eyes that people.
Speaker 3 (12:11):
Are doing it, but that we were.
Speaker 4 (12:13):
Going to have to seek it out a little bit harder.
Speaker 1 (12:16):
There's a few things you just brought up. So number
one is for a lot of us, whether it's a patient,
and again, like you said, Tom, we're all people that
eat that there's often this awakening moment and it can
come from a personal experience. And I see that as
kind of a target of having to think about ourselves
and what change we do, and then if we see
that change, then taking it outward. And that's what I
(12:37):
have loved about what got you interested in this and
then taking it beyond yourself of realizing how do I
find this and when you didn't find it in medical school,
how do I create it? Which is giant.
Speaker 5 (12:50):
Let's surprise you the most of the process of developing
the workshops, and how have you found that these workshops
are different than traditional kind of You mentioned biochemistry a
couple of times, how that nutrition teaching that you've gotten.
Speaker 4 (13:04):
I'll start with the obvious change between them is that
there's the hands on component, and that has been so
crucial to get students involved and to learn like experientially,
because that's not something that everyone feels comfortable or equipped
to do at home. And I think that a lot
(13:25):
of the reason that people don't have these skills is
because it feels like there's such a.
Speaker 3 (13:32):
Barrier to entry.
Speaker 4 (13:34):
So I think that lowering that by offering some kind
of hands on learning with some supervision and teaching, is
crucial to people actually taking it home. Learning any kind
of lecture, people are half listening and plan to go
do more at home. But I think this is one
(13:54):
of the things where you can't just go home and
watch a video and just get it. It's something that
you really have to get from being like, oh, I'm
holding the knife this way.
Speaker 1 (14:04):
There is added value and really thinking of the teaching
kitchen that we create as a learning lab, right, so
we are learning these skills, we're learning about working in community.
So yes, a lot of learning thresholds. If you had
to guess what percent of your peers or colleagues actively
embrace food is Medicine today.
Speaker 2 (14:23):
Yeah, I think that there's a very low number of
people that would disagree with the idea in its conceptual form.
The question is do they apply it to their daily practice?
I would think, and I think very very few is
the answer. And it's not because anybody's doing anything wrong.
It's simply that it's not a skill set and it's
(14:45):
not something that's incentivized in large health systems or even
academic medical centers where you're trying to work through, especially
in internal medicine, people with multiple medical issues and competing priorities.
Speaker 1 (15:00):
All Right, So Megan, as you've gone through this process
and now you've started to see patients in different capacities,
what is one skill or concept that you learned that
you wish every med student could take or that you
have experience now with some patients.
Speaker 4 (15:15):
I think in a patient setting, I haven't had as
much experience to bring up nutrition as much as I
wish that I had. I'm pretty early in my third year,
but I think in terms of culinary medicine in general
and the skill that I wish I could have applied
(15:36):
to all my classmates and honestly to all of the
patients that I meet, if we had the chance to
speak about it would be ingredient preparation rather than meal preparation.
And this is speaking mostly to like people who feel
very busy all the time, and I think that's a
huge barrier to entry for just cooking in general and
(15:57):
having home prepared meals. And that's something that we've emphasized
in the workshops of just preparing ingredients rather than entire meals,
because if you make one big you know that of chili,
like you said, and then you have to eat that
for lunch and dinner and lunch and dinner and on repeat,
and then you're sick of that recipe. And I think
(16:21):
that can be kind of disheartening when you get up
the courage to cook yourself a home cooked meal. So
I think that's something that a lot of my classmates
have struggled with, and just a lot of people struggle
with in general that I try to mitigate with just
ingredient preparation and really looking at cooking as something that
(16:41):
you get to do every day, but not something that
you have to do that's going to take so long.
So we've shown, you know, preparing your greens and washing
and cutting and then preparing like a veggie saute and
then maybe some beans, or we've showed the ways that
you can create various ingredients that are going to be
(17:02):
quick to throw together, but in completely different organizations.
Speaker 2 (17:08):
What I end up stuck on with patients oftentimes is
they want to know what diet to follow, and they're
not actually looking for nutrition advice or meal preparation advice.
They want to basically sign up for a diet. Maybe
they don't really want to, but that's what their friends do,
and that's what their family does. They're vegan or their carnivore,
or there's some infinite derivation of either of those, and
(17:32):
I think that becomes an identity thing oftentimes. And so
the problem with diet as a term, and something I
try to avoid talking about, is that people hold very
strongly to the identity of being such a person, a
vegan or a carnivore or a keto or paleo or
whatever it might be. And so what I try to
do is walk people back from that. And I think
what Megan was highlighting, at least what I heard was
(17:55):
it's a skill set of being creative with nutritional ingredients,
and those are common to all these different diets. They
don't have to be dogmatic. You can get benefit out
of some carnivore, some paleo, and some vegan. That's called
a balanced meal probably, you know. But if you call
it the Mediterranean diet, people will say, oh, yeah, I
know that I should eat olive oil and feta cheese
(18:16):
or something. So I like to really emphasize the idea
that this is a skill set and the ingredient focus
is really the important thing, because if you have it
in the house, you'll be able to use it to
create your meal. If you have a bag of chips,
you'll be able to consume that quicker than you would
ever create a meal. And so I try to focus
on their habits. Frankly, when it comes to shopping, when
(18:40):
it comes to discussion of meal preparation, it's don't buy
the thing you know you're going to consume. If it's
in the house. Because willpower is sort of a fleeting energy.
I try to focus on, Okay, buy the stuff that
would be good to eat if you end up eating it,
you know, and then next step, let's create some meals
out of it. And I just appreciate what Megan said
about that it is a barrier for people to start
(19:02):
thinking about it. I got to have a recipe, and
I need a quarter a teaspoon of nutmeg or something,
you know, I don't have nutmeg. It turns out the
recipe is going to be pretty much fine without the nutmeg,
you know, like you can get most get ninety percent
of the ingredients and you'll be all right. It's not
about diet. It's about nutrition. It's about starting to get
creative with the ingredients you have and setting yourself up
for success by buying those things at the store.
Speaker 1 (19:24):
So coming back into the clinic for a bit, you
may or may not be aware that there was actually
In twenty twenty four, doctor David Eisenberg of the Harvard
School of Public Health, along with colleagues, published a new
set of competencies in JAMA Network Open, looking at competencies
to be incorporated into medical school curriculum, and the goal
(19:46):
really is looking at nutrition to really bring it in,
giving the language to medical students to understand, to be
able to take it to the next step. So, Tom,
when you look back, is there a skill that you
wish you had learned, Like, if you had to, Okay,
I'm going to have four hours of nutrition education or
food conversations, what do you feel would have been kind
(20:06):
of the highest ticket item on that list?
Speaker 2 (20:10):
I mean, I don't want to sound flippant, but the
most I mean the thing I could have gotten the
most out of, or the thing I would have received
the most benefit from, would have been to be taught
how to cook five dinners in a week within twenty minutes.
You know, basically the thing that most people are dealing with,
which is the pressure of time. And maybe I don't
(20:30):
need to know all the reasons why this particular nutritional
component is so good for my mitochondria or what have you.
I just need to know that this is a good choice,
because that's human behavior. And if I can explain it
to myself and make my dinner in a healthy way,
there's a higher likelihood I'll be able to explain that
to a patient or a friend who might be in
(20:51):
need of it. If I become distracted and go down
the rabbit holes of macronutrients, micronutrients, supplements and all of
those things, nobody's going to pay attention, you know, at
least not for very long.
Speaker 1 (21:04):
So going along with that, when we're now looking at
ethics and food programs, how do you balance offering helpful
resources without steering patients to one company or one product
or one specific diet or a way of eating. And
what are the ethical considerations that you take into account
with this.
Speaker 2 (21:22):
Here's the thing I did a when I was in
a residency. I had a clinic that was in a
lower socioeconomic area of the county, and people really didn't
have resources to go to the high end grocery store
or go to a restaurant where they're going to get
a salad or something, and so I was always left
(21:42):
with saying something to people like don'y white rice or
dony tortillas, and frankly I knew because you can see
it in their eyes. As soon as you say that,
they basically tune you out because that's what they're going
to eat, you know. And it's not because they're trying
to worsen their diabetic contry, but it's their culturally appropriate
(22:02):
and important food, and so, you know, the thing that
I ended up learning was that instead of saying don't
eat this, don't eat that, I would try to offer alternatives,
like more veggies instead of that pile of rice or
you know, whole weed versions of things. Even that didn't
always get a lot of purchase, but at least it
(22:24):
made it clear that I was trying to stay aligned
with their cultural what was important to them culturally. Nowadays,
I don't worry as much about shying away from specific
recommendations regarding grocery stores or products, because I feel like
my main objective is to help my patients or clients
(22:45):
actually do what they need to do. And the more
specific you can be, the more helpful you can be.
I think, when you're dealing with the person in front
of you, it's important to know where they live, what
resources they have access to, and then do your research.
Go to the store and figure out what do they
actually say sell there, and you can say, hey, on
Aisle three, they got kale.
Speaker 1 (23:02):
You know, I loved hearing how you transitioned Again, you're
in residency with not much education around this topic, and
you are in the trenches now, Megan, do you want
to add anything to this. I do.
Speaker 4 (23:16):
I've just been loving hearing from both of you about
how your focus is really less about what specific diet
to prescribe or recommend, and I agree that it's really
not about that at the end of the day, and
that's great news for every physician who feels that they
don't have an adequate understanding of which diet is better
(23:39):
than another, because I think that at the end of
the day, it's just about getting people to eat more
of what's fresh and what brings them joy.
Speaker 3 (23:50):
And I think that really diving.
Speaker 4 (23:52):
Into what foods are comforting and which ones are comforting
and go for you, and really trying to understand what
is someone's health literacy as long as you're trying to
tailor it to your specific patient and their background. And
(24:13):
that's something that we've really tried to do in our
workshops and something that I really appreciate too, because again, yeah,
the Mediterranean diet is evidence based, but it's really not
that inclusive and it doesn't apply to every food that everybody.
Speaker 3 (24:28):
Enjoys and grew up knowing.
Speaker 4 (24:30):
And I think that's one of the best things about
food is that people think about things that my mom
made or in our workshops we know applied other cultural
cuisines and our entire premises these are the Mediterranean diet principles,
and here's how you apply it to other cultures. And
(24:52):
we got feedback from students who wrote in saying, my
mom made this, or my grandma made this, or.
Speaker 3 (24:58):
I order it take out. I didn't know that you
could just make it.
Speaker 4 (25:02):
And food can be incredibly empowering to know how to
make it yourself. And someone's relationship with food is just
as important as what they're actually eating.
Speaker 2 (25:15):
That is such an important point, and it applies to
many different aspects of behavior change. I would say that
not emphasizing getting down on yourself for lapses from whatever
the ideal plan you had created at the beginning of
the week is one of the more important things that
I think I've found in direct patient care. I think
(25:35):
it's important to also advocate for people to feel good
about themselves in getting back on track after lapse or
after something that maybe doesn't meet the perfect nutritional guidelines.
It's also, I think really important to give people credit
for small improvements and to encourage them to give themselves
(25:55):
credit for small improvement. So if they go from eating
out seven nights a week to creating two meals in
a week, that's a huge improvement. And that's sort of
that you know, coefficient of static friction or whatever the
term was in physics where it's the hardest thing to
overcome is that inertia of never cooking to cooking just
a little bit. And if they can do that, just
(26:17):
like if they can go for a one mile walk
or a ten minute jog or something like that, they've
started that process of habit change. And that's really what
human behavior is all about. That's where I try to
lean in and I say it, great, you made two things.
What were they?
Speaker 1 (26:31):
You know?
Speaker 2 (26:31):
I'm interested to learn, And again, asking and being curious
is more more valuable than lecturing and saying, hey, you
got to you know, eat this many carbs and grams
of fat.
Speaker 1 (26:43):
Et cetera. How realistic is it for a clinician to
give practical food or meal advice in a fifteen minute visit? Tom,
I'll start with you, since you've had many decades of
experience with this.
Speaker 2 (26:54):
Geez, many decades. I've had a couple of decades of
experience with this type of visit. I've chosen a practice
now where I have a little more time, which I appreciate,
but I can still tell you that there's never enough
time to fully address every issue that a person wants
to discuss or needs to discuss. And so the strategy
(27:17):
that I encourage amongst other physicians and residents and medical
students is not to try to solve the problem in
fifteen minutes, but to simply start the conversation, because at
least in primary care and in many specialty clinics where
they're seeing people over and over again, these are conversations
which can occur over and over again and progress over
(27:41):
the relationship with your physician. And I think that's the
most valuable thing, is that if they have consistency, if
the patient comes in and knows, oh, doctor Carter's probably
going to ask me how I'm doing with my nutrition,
I better have a recipe this time that I know
to tell him, because he keeps asking me what's the
recipe that you're going to make tonight, which is the
thing I ask. I try to act very I try
(28:01):
to ask a specific question, and so I think iterative
repetitive questioning over multiple visits about what people are eating
or what they are going to make that night is
actually my biggest recommendation, just like it is for exercise.
What is the exercise you're going to do today? Is
the question? Not in general what do you do for exercise?
(28:24):
Because then people say, even if they're sixty years old, oh,
I played high school football. You know, well great, you know,
but that.
Speaker 1 (28:32):
Was a few decades ago.
Speaker 2 (28:33):
That one that's not relevant anymore, you know, Or I
used to be a vegan four years ago, like, okay,
well what are you going to make for dinner tonight?
You know, that's really the question. And so to get
back to your question, fifteen minutes is inadequate to address
fully anything any topic. You can do tactical addressing of
certain things that are acute. You can check some boxes.
(28:55):
But what you really need, as a physician, I think
to get comfortable with is that these are longitudinal conversations
that are occurring in fifteen minute increments over a period
of ten years and so or more. And if you
do that, then their relationship develops. And caregiving is about relationships,
and nutrition can weave into that just like all other
aspects of that physician patient relationship.
Speaker 1 (29:17):
Do you want to reflect on that Megan is starting
this journey.
Speaker 4 (29:22):
Yeah, I mean I love that approach. I think it's
very inspiring to I mean, we learn about the basics
of motivational interviewing. That's something that medical school does really
touch on because it comes.
Speaker 3 (29:35):
Up in so many different aspects.
Speaker 4 (29:37):
And people really have it dialed with smoking, cessation and exercise,
but then it does seem like with nutrition we shy
a little bit further away.
Speaker 3 (29:47):
And I want to touch on the fact that.
Speaker 4 (29:49):
I think the beauty of although you can't fit an
entire overhaul or an entire you know, deep dive into
someone's relationship with food or have it changes in fifteen minutes,
I think you can touch on it. And I think
that continuity is important. But even just for people that
don't have that privilege of continuity, I think it's worth
(30:13):
it because I think people want to know that their
doctor cares. And the beauty of culinary medicine is also
that it's interdisciplinary. And I've been in many settings now
where actually the dietician is leading that conversation, but the
physician is beautifully teeing them off.
Speaker 3 (30:32):
Because we learn about, you.
Speaker 4 (30:34):
Know, real blood pressure changes when a physician walks into
the door and things like that, like coat syndrome. People
do care about what their physician says, and I think
being able to reinforce that with other members of the
team is really important and it just gives people more
touch points.
Speaker 1 (30:56):
So, where as we're closing up here, is there anything
I didn't ask you that you wish I had, so
please share that?
Speaker 5 (31:03):
Or what's one thing that you hope med.
Speaker 1 (31:05):
Schools to do differently in the next five years?
Speaker 4 (31:08):
Your question about what do I hope that med schools
will do differently in the next five years tease us
off very well from the conversation we were just having,
because I do think that my biggest passion about our
project with the workshops has.
Speaker 3 (31:24):
Been that I really have wanted.
Speaker 4 (31:28):
People to focus on themselves first and really build that
skill set for their own week night, you know, dinner,
and feel more comfortable with it themselves because it's such an.
Speaker 3 (31:43):
Element of wellness.
Speaker 4 (31:44):
It is one of the biggest ways that I stay well,
and I just find so much power in that and
being able to do that and not feeling helpless and
you know, creating a meal that makes you, in turn
feel really good. I think that that component of wellness
is something I hope gets integrated into medical schools because
(32:06):
they are so passionate about wellness. And I think there's
been many conversations from the medical school even asking us,
and I really commend UCSD for asking students like, what
do you want your wellness to look like? And I
have raised my hand in a big auditorium and said,
I think we need more gulinary medicine. And I hope
(32:26):
that they did that and run with it eventually, but
it hasn't happened yet. But I think that they are
starting to realize that if you can do it yourself,
then you can help patience. And we're starting with that
first step, and a lot of my classmates have actually
really bought in. And I've been getting texts like weekly
to monthly of somebody sending me a picture of something
(32:49):
that they made and saying, look how good this looks,
or I was inspired by you or your workshop, And
it's just been such a joy to see people just
take it for themselves and about.
Speaker 3 (33:00):
The patients too. But right now, my goal is to really.
Speaker 4 (33:02):
Get people to incorporate that into their own lives and
then feel confident with just sharing it with a patient
like they would share it to a friend.
Speaker 2 (33:11):
As far as a closing reflection, this is really fun,
and I hope we get to keep having interviews over
a podcast. Thank you. And I think that a reflection
is that we're all I mean, we're really all just
trying our best for the most part, I would say,
and it doesn't really benefit anybody to pretend that you're
an expert in something you're not an expert in. And
(33:34):
I think that took me a long time to let
go as a professional physician, because there is this sort
of attitude that people are coming to you for knowledge,
for your knowledge, for your experience, and for you to
basically give them the answer. I think that's maybe a
relic of my educational time in your Sabrina, where we
(33:55):
were essentially wrote learning and spitting it out and memorizing
mnemonic so that we could get at all of the
criteria of acidic fluid and plural fluid, right, And that
Creb cycle that I kind of is, you know distantly,
Remember I don't remember the Creb cycle. So hopefully I
can reassure you that you will not need to know
it at some point. I've never said ATP in the
(34:16):
clinic in my entire life, So just so you know,
and and I think that I would, I would hope,
and I'm and I'm you know, a facult a clinical
faculty faculty member at UCSD, and I'm hoping to impart
this sort of attitude over time as well, that there
is a role for knowing that information for a period
(34:38):
of time. But really the art and the practice of
medicine is about partnership with other human beings, and so
learning the skill set to live your own life in
those ways is probably the most powerful way you can
help others, because that's how we teach each other. We
teach each other what we do, and they see us
as examples. It's something that I think about because I
(35:00):
I do now try to live in the way that
I ask my patients to try to live. And I
think we just have to understand that that could start
way earlier in medical school, even earlier probably, but as
you arrive in medical school, I'd love students to be
able to be encouraged to learn a few good recipes
and to learn a few good exercises, and maybe some
(35:22):
creative outlet like reading a novel and other things that
are good for your brain and totality rather than just
cramming information.
Speaker 5 (35:31):
So, Tom, how can people reach you?
Speaker 2 (35:34):
I have email? My email is Tom at Cartermedicalcorp dot com.
Speaker 5 (35:40):
How about you, Megan.
Speaker 4 (35:41):
I'm very passionate to share, and the best way would
probably be email right now because I am checking it
all the time.
Speaker 3 (35:49):
So mroacch Roach like the bug at UCSD dot edu.
Speaker 5 (35:58):
Perfect. Thank you both so much.
Speaker 1 (35:59):
Was It's really fun and I really love to hear
the conversations of us in very different stages of our
career journey. So thank you Megan and Tom for this
time together.
Speaker 3 (36:11):
Thank you, Sara, thank you.
Speaker 1 (36:16):
Today's conversation with Megan Roach and doctor Thomas Carter highlights
both the progress and the gaps. We see the hunger
for culinary medicine from students who sign up within minutes
for culinary medicine workshops and from practicing clinicians who fill
every seed of cooking demonstrations to learn new skills. We
also see how little formal nutrition education most physicians still receive.
(36:37):
We're beginning to see signs of progress, though, with Congressman
Jim McGovern has spoken out in support of nutrition education
and medical training and the Eisenberg competencies have been published,
and some medical schools offer formal electives or even full
courses of culinary medicine, but we're not there yet. To
truly transform care, every medical school graduate, regardless of specialty,
(36:59):
needs to leave with practical nutrition knowledge they can carry
into their own unique practices. Until next time, salute and
buena Pettie. All content provided or opinions expressed in this
episode are for informational purposes only and are not a
substitute for professional medical advice. Please take advice from your
(37:22):
doctor or other qualified healthcare professional.
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